Women’s Health, Pregnancy and Bariatric Surgery: Your Questions Answered

Is weight management a women’s issue?

It shouldn’t be – but it is. Australian data shows a slight preponderance of men who are overweight or obese; however, those that seek weight loss management options, particularly bariatric or metabolic surgery are predominantly female (80%). According to the Bariatric Surgical Registry, the mean age for seeking surgery is 43.9 years with average BMI of 42.9 at the time of procedure.

Weight is a women’s health issue. Clinically severe obesity is associated with increased comorbidities associated with metabolic syndrome, but some are worse in females such as type 2 diabetes, coronary artery disease and osteoarthritis. For females the importance also comes from infertility (particularly the association with Polycystic ovarian syndrome), pregnancy and delivery, breastfeeding and some cancers (endometrial, ovarian, cervical and breast).

Women’s Health, Pregnancy and Bariatric Surgery western surgical health perth

Is there a relationship between obesity and a patient’s fertility?

Yes – fertility is reduced in obese patients who can be oligo-ovulatory or anovulatory.  A Danish review of 10,99 pregnancies found women with BMI over 25 have a 23% lower change of pregnancy per cycle (1).  Similarly, patients with BMI over 30 are twice as likely not to conceive over 12 months and 30+ are seven times less likely to conceive.

The pregnancy itself can be affected by obesity – there is a higher risk of gestational diabetes, pre-eclampsia and of an interventional birth.  There is a higher operative intervention rate of caesareans and higher wound infection rates.  Being obese and pregnant also adds an extra layer of issues – twice as much reflux-like symptoms, three times the symphysis-pubis pain and carpal tunnel risk and a ten-fold risk of atelectasis (2).  Having a BMI of 30-40 correlates with a 3-fold risk of gestational diabetes (3).

obesity and fertility western surgical health perth

How does bariatric surgery affect pregnancy outcomes?

Current guidelines advise against pregnancy within the first 12-24 months after bariatric surgery. There are several large studies of birth outcomes in clinically severe obesity. Of 1382 gastric banding patients there was no statistically significant difference in neonatal outcomes found (of stillbirths, preterm delivery or macrosomia).  Of those who did conceive within a year of bariatric surgery no significant difference was found of hypertensive disorders or GDM but there was a higher caesarean rate, likely due to caregiver bias (4).

Is obesity and cancer related?

Cancers associated with higher endogenous oestrogen levels have been well considered in the literature and most likely to affect females suffering from clinically severe obesity. These include endometrial, ovarian, cervical and breast cancer.

We do know that higher BMI patients have greater risk and worse survival rates. In general terms they have later screening opportunities, higher rates of weight-related comorbidities, their treatment response may be compromised and they are at greater risk of surgical complications such as wound infection and seroma formation.  Radiotherapy has a lower penetrance and there may be chemotherapy dosage issues.

How should doctors approach the topic of weight management?

In short – with consideration and empathy. A personalised approach is best and the patient’s General Practitioner who knows them best is perfectly placed for this.

  • Approach the discussion in health-related terms – if there are comorbidities associated with weight, this is the ideal starting point. Do not blame the patient or stigmatise the issue – obesity is a chronic disease and the patient should be supported in management.
  • The number on the scales is *not* the issue – this does not accurately reflect their skeletal muscle mass, body fat percentage or basal metabolic rate nor is it standardised for age or sex. It is used purely as a starting point for the discussion, but the aim of any weight management plan must be health and decreasing severity of comorbidities.
  • A multi-disciplinary approach – a well-constructed program should encompass a allied health professionals including dietetics and psychologist alongside specialist medical practitioners, allowing adjuncts such as pharmacotherapy or referral for surgery if appropriate.

References

1.         Jensen TK, Scheike T, Keiding N, Schaumburg I, Grandjean P. Fecundability in relation to body mass and menstrual cycle patterns. Epidemiology. 1999;10(4):422-8.

2.         van der Steeg JW, Steures P, Eijkemans MJ, Habbema JD, Hompes PG, Burggraaff JM, et al. Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women. Hum Reprod. 2008;23(2):324-8.

3.         Torloni MR, Betran AP, Horta BL, Nakamura MU, Atallah AN, Moron AF, et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev. 2009;10(2):194-203.

4.         Sheiner E, Edri A, Balaban E, Levi I, Aricha-Tamir B. Pregnancy outcome of patients who conceive during or after the first year following bariatric surgery. Am J Obstet Gynecol. 2011;204(1):50 e1-6.

Click on the links below to view the most popular weight loss surgeries that we offer at Western Surgical Health.

Gastric Banding

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Gastric Sleeve

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Perth’s Western Surgical Health

Our care is unique in that we provide highly specialised professionals all at one location to support you in your surgery.

Our team includes:

– Specialised Bariatric Surgeons (both male and female)
– General Surgeons (both male and female)
– Bariatric Physicians
– Accredited Practising Dietitians
– Specialised Psychologists
– Exercise Physiologists